Challenges in Managing Autism Spectrum Disorder (ASD) in Low-Resource Countries

Autism spectrum disorder (ASD), a neurodevelopmental disorder, presents core social communication/interaction insufficiencies and restrictive, repetitive behavior patterns. ASD affects all races and ethnicities, but differences exist in prevalence rates at the global, national, and regional levels for several reasons. 

Early diagnosis of ASD is essential for providing early intervention. Increasing evidence shows that early intervention is associated with better outcomes. 

Parents often approach the pediatrician if they have any concerns about their child’s development. Hence, they must familiarize themselves with the early symptoms and signs of ASD. Early warning signs of ASD contain speech delay or regression, poor eye contact, hardship in social interaction, and a lack of gestures to express interest. The child may not engage and be restricted in his/her own world. These Children often have sensory issues. Common comorbidities are ADHD and epilepsy. The pediatrician must evaluate the child in detail, considering these aspects. A list of red flags benefits the busy pediatrician who cannot do a detailed developmental evaluation. The investigations, including genetics, have a limited role in the diagnosis, thus, should be judiciously ordered. The physician must also be familiar with some locally available autism-specific screening tools.

Furthermore, in low-resource countries, Expert services for early intervention are limited; hence it is important for pediatricians to know the practical aspects of the management of children with ASD. Evidence-based approaches include developmental, behavioral, and educational interventions by professionals or parents. Pharmacological therapies are used as adjuncts to treat severe problem behaviors as needed. It is also important for the pediatrician to discourage parents from spending resources on therapies with no evidence-based benefits. Pediatricians can also provide anticipatory suggestions and help parents access proper resources for managing their children.

Nevertheless, many more challenges are associated with the early diagnosis and management of ASD at the community level in low-resource countries, like the lack of available culturally suitable tools that are scientifically valid and the prohibitive cost of using gold-standard tools. 

Strategies to provide education at every healthcare system level, from medical providers to professionals and paraprofessionals who engage with children and their families in other settings, along with the need for team-based strategies, private–public partnerships, and international collaborations, are crucial for early diagnosis and management of ASD, particularly in low-resource regions.

Singhi P, Smith-Hicks C. Early Diagnosis and Management of Autism Spectrum Disorder (ASD) in Low-Resource Countries—Challenges and Strategies. Indian J Pediatr. 2023; 90:362–363. https://doi.org/10.1007/s12098-023-04481-4